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Five of our articles find different ways of ‘touching a nerve’.
Nerve conduction velocity was the objective way that by Schroeder et al measured the effect of acupuncture on patients with peripheral neuropathy due to chemotherapy. The results look exciting, though readers will be cautious about drawing conclusions since the control patients were self-selected (unable to get to clinics for treatment) and were less severely affected, leaving less scope for change. That said, the cumulative evidence now published suggests that it is time for a rigorous sham-controlled study.
Some readers may share the Editor's ignorance of the word ‘mitempfindung’. It is the phenomenon where touching a nerve at one site produces the sensation of itch at a remote site. Silberstein noted in himself, went on to explore it systematically, and combined his findings with some previously published reports. All this careful work suggests that mitempfindung could be the origin of the meridians. He also suggests one possible neurological basis for the phenomenon. In a commentary, Campbell reminds us that meridians appear to have originally been conceptually distinct from acupuncture points, and highlights some research questions that flow from this paper.
A Neurometer was used by Wu et al to test the perception threshold changes with electroacupuncture (EA). Low frequency and high frequency EA in the hand produce different patterns, and the arm responds differently from the mandibular area. It is important to distinguish any effect on perception threshold from any effect on pain threshold. And they are both different from clinical pain. But this new method helps understand the mode of action.
In volunteers, Musial and colleagues find acupuncture as effective as tramadol in reducing the pain threshold.
The median nerve, and whether it is touched by needling PC6, was the objective of an anatomical study by Oh and colleagues on cadavers.
In other clinical papers, Lee et al report a pilot study of acupressure's effect on lichenification in patients with eczema. Our conclusions should be cautious since acupressure was compared to no intervention, so non-specific effects cannot be ruled out. And Birkeflet and colleagues take an objective look at TCM diagnosis, identifying three types associated with infertility. Interestingly, they were different from those commonly cited in textbooks for the condition. That's what science is all about.
The paper on moxibustion by Tanaka et al continues these authors' work and shows that heat generated is greater when moxa is applied at several sites rather than repeated at the same site.
The laboratory study by Zhou et al identifies an effect of electroacupuncture on bone loss due to ovariectomy. This work is stimulating, though of course a long way from clinical application for prevention of osteoporosis. And in summarising a good number of laboratory studies, Li and colleagues explore possible modes of action of acupuncture on the cardiovascular system.
Then we have some fascinating case reports. Norheim and Mercer saw a dramatic alteration in the thermal image of a patient's hand immediately before the patient fainted (see figure 1). This is entirely reasonable of course, yet is the first time it has been reported. Readers are invited to work out how to use this finding as an early warning system! Kopsky and Hesselink report a patient whose pain responded very temporarily to acupuncture, but much better when care included a newly available medication, palmitoylethanolamide. This compound is believed to have a role in the function of glial cells.
The last two reports describe what seem to be responses to acupuncture in patients with difficult conditions. In severe sensorineural hearing loss, Huang and Li caused the reviewers some difficulty since the patient's condition appears to have been Meniere's disease, though the clinician who cared for the patient was convinced otherwise. And Foell encircled and drove off the dragon known as ecthyma gangrenosum.
Competing interests None
Provenance and peer review Commissioned, internally peer reviewed.
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